What killed the famous tenor?

UM doctor looks at Lanza's death at 38

was it due to risky weight-loss treatment?

A half-century after his untimely death at the age of 38, celebrated tenor and movie star Mario Lanza is receiving fresh medical attention from a Baltimore doctor who takes a dim view of one of the singer's weight-loss treatments - injections of the urine of pregnant women, a controversial therapy with new followers today.

Dr. Philip A. Mackowiak, vice chairman of medicine at the University of Maryland School of Medicine and director of the Medical Care Clinical Center at the Veterans Administration Hospital downtown, teamed up with Armando Cesari, Lanza's Australia-based biographer, for an article about the singer's health issues just out in The Pharos, the journal of the medical honorary society Alpha Omega Alpha.

Mackowiak is widely known for his annual conferences devoted to investigating notable deaths, from Alexander the Great to Booker T. Washington.

"Armando picked up a report on one of them and e-mailed me, suggesting that Mario Lanza would be an appropriate subject for a conference," Mackowiak says.

The Philadelphia-born tenor, who died unexpectedly on Oct. 7, 1959, in Rome of an apparent heart attack, didn't meet all of the requirements for the conference - household-name status, a mysterious illness and enough historical records to generate a diagnosis. Still, Mackowiak found himself intrigued by the case.

"I wasn't really a Mario Lanza fan, although I'm old enough to remember him," Mackowiak, 63, says. "I got Armando's book and read it. I also listened to the CD of Lanza recordings that comes with the bio. The performances are absolutely fabulous. He was incredible. I decided Lanza's death was worth investigating."

Lanza, who performed in only a couple of complete operas before being snapped up by MGM, was not always the subtlest of singers, but he possessed a voice of natural beauty and expressive power. Not surprisingly, his biggest movie hit was the title role in "The Great Caruso" (1951).

The tenor inspired many operatic artists, including Placido Domingo and the late Luciano Pavarotti. Like the latter, Lanza faced a battle of the bulge. He was obligated to shed the pounds before each film.

"The pressures drove him to drink and to eat," Mackowiak says. "He dealt with his anxiety by eating, and his eating was just legendary. He once ate 2 1/2 chickens at one sitting. Can you imagine? The pressure to get that weight off at Mach speed for the movies - that was big-time unhealthy."

Lanza, 5 feet 7 inches tall, weighed more than 250 pounds when he died. For film work, he would aim for 169. Among the crash methods he tried was a dangerous "sleep therapy" at a German clinic in 1958. The previous year at a Rome hospital, he was injected with daily doses of hCG, the hormone human chorionic gonadotropin - derived from the urine of pregnant women - and allowed 500 calories daily.

"I knew absolutely nothing about hCG," Mackowiak says. "Lanza lost 30 pounds in nine days, and 40 more over the next three months. That's not possible with diet and exercise alone. Advocates today are making absolutely phenomenal claims for hCG, of which some of the most preposterous are that people's appetite sort of just goes away; and they not only lose weight, but lose it from the places where they want to lose it. It's probably not good for anybody."

In an e-mail from Australia, Cesari says that "the most surprising thing" he learned from collaborating with Mackowiak "is the danger associated with hCG."

Since Lanza apparently tried that therapy only once, "I therefore believe," Cesari, 68, writes, "that the cause of death was by pulmonary embolism as a result of the deep vein thrombosis Lanza was suffering from, and the blood clot that became detached causing the fatal heart attack."

Adds Mackowiak: "I also believe he was made hyperthyroid toxic by the use of hCG."

Reaching an ironclad analysis is complicated by a shortage of medical records. Efforts by Cesari and Mackowizk to interview the tenor's personal physician in Italy were rebuffed.

All that is known with absolute certainty is that an exceptional voice was silenced much too soon.